Treatment of colchicine intoxication, including the management of drug interactions

Colchicine features a narrow therapeutic range, and intoxication may cause multiorgan dysfunction. We present a case of a man in his 70s who experienced an accidental colchicine overdose (11 mg over 2 days) and was treated in our intensive care unit (ICU). He presented with haemodynamic instability as well as reduced consciousness and subsequently developed anuric renal failure, respiratory failure, thrombocytopenia, leucopenia, cardiac arrhythmias and gastrointestinal paresis. In addition to administering charcoal to reduce colchicine absorption via enterohepatic recirculation, therapy was mainly supportive, focusing on avoiding any drugs that might delay colchicine elimination, that is, inhibitors of cytochrome P450 3A4 and the P-glycoprotein pathway. After 58 days in the ICU, the patient was transferred to a specialised facility to recover from his severe ICU-acquired muscle weakness.